Psychotherapy and Bipolar Disorder

This article describes the types of psychotherapy that appear to be most useful for people with bipolar disorders, and mentions which kinds of patients are most likely to benefit from each. As mentioned previously in this chapter, many good therapists use techniques and concepts from several of these disciplines.

Cognitive Therapy

Insurance companies love cognitive therapy (also called cognitive-behavioral therapy), because it sometimes produces relief from troubling symptoms within a defined, limited period of time. Patients like that too, especially those who are strongly motivated to help themselves.

The cognitive therapist begins by helping the patient identify which negative behavior patterns he would like to work on. Together, they identify what kinds of thoughts and feelings precipitate these behaviors.

Next, the therapist helps the patient figure out strategies for replacing thoughts that have negative consequences with new thoughts that have positive consequences. In other words, the cognitive therapist helps you “think yourself well.”

In addition to bimonthly visits with her neurologist and psychiatrist, Cass sees a therapist weekly for an hour. His focus is behavior modification, and he is her friend. She loves to see him. I have a distrust of therapists, but am very comfortable with him. He has helped me to work with specific goals in mind for her. –Stephanie, mother of 7-year-old Cassidy (diagnosed bipolar disorder, Tourette syndrome, OCD, ADHD)

Cognitive therapy works best for handling specific “thought errors” and behaviors. For example, if a teenager with bipolar disorder tends to catastrophize when depressed, seeing only the negative side of everything and then becoming further depressed as a result, cognitive therapy can help him find strategies for breaking this negative thought spiral. These strategies might include the use of affirmations, consulting with the therapist or another trusted adult to double-check negative thoughts, or mentally substituting positive thoughts for the negative ones.

Does it work? Not always, but more often than one might think. Cognitive therapy has helped many people identify and combat errors in thinking, and has even proved useful for stopping thoughts that can lead to troubling behaviors, including self-injurious behavior. It has a good track record for helping people with compulsive behaviors, those in recovery from substance abuse or dependency, and patients suffering from anxiety, panic, and other out-of-proportion reactions to daily events. Evidence is mounting that cognitive therapy produces actual physical effects, such as changes in the production and absorption of neurotransmitters.

In the hands of a professional who has strong rapport with young children, cognitive therapy can be a powerful tool, even for preschoolers. Not every therapist has the ability to work well with this age group, however. It has been well-tested for use with adolescents and teens.

Cognitive-behavioral therapy has also shown effectiveness for educating bipolar patients about monitoring their mood cycles and symptoms, and for encouraging treatment compliance.

Play Therapy

Young children express their fears, desires, and emotions in play, and they can often be reached and helped through the medium of play when conversation with an adult is impractical. Play therapists are specialists in this kind of therapy, which can work powerful magic when done with skill and caring.

Play therapists can work with children as early as infancy to build and improve skills in the areas of attention, interpersonal relationships, perception, and mood. They can also help young children who have been victimized by abuse or who have experienced other kinds of life traumas, such as the death of a parent.

Michael’s therapist does play therapy, which is what works best with my son. At the beginning she concentrated on his sexual abuse issues. When that got better, the focus was whatever was going on at the time. If he was paranoid, they would talk about that. Self-esteem is always an issue. They discuss bipolar disorder and what it means for him.
–Lynn, mother of 11-year-old Michael (diagnosed BPI with mixed states and psychosis, OCD, tic disorder)

There are many tools for play therapy, and many schools of thought. One of the most interesting types for use with young children is called floor-time play therapy, and is championed by Dr. Stanley Greenspan. The techniques of floor-time play involve creating structured play sessions with a client–or with your own child, because this is one kind of therapy that parents can deliver with ease–that help him overcome deficits in attention and relatedness. Filial therapy is another type of play therapy that uses similar ideas, and involves parents or other caregivers taking turns at initiating structured interactions.